Provider Demographics
NPI:1043278435
Name:SIMON, MARLA MARIE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:MARIE
Last Name:SIMON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7685 W PIQUA CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45318-8802
Mailing Address - Country:US
Mailing Address - Phone:937-473-2919
Mailing Address - Fax:937-473-2124
Practice Address - Street 1:7685 W PIQUA CLAYTON RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:OH
Practice Address - Zip Code:45318-8802
Practice Address - Country:US
Practice Address - Phone:937-473-2919
Practice Address - Fax:937-473-2124
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN130747367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0716167Medicaid
OH000000286052OtherANTHEM #
OH000000286052OtherANTHEM #